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Salvage interstitial brachytherapy for treatment of recurrent endometrial cancers in the vagina: Seven-year single institution experience and review of second recurrence patterns 用于治疗阴道复发性子宫内膜癌的挽救性间质近距离放射治疗:七年单一机构经验及二次复发模式回顾。
IF 1.7 4区 医学 Q4 ONCOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.brachy.2024.09.007
Marissa Sherwood , Toni Barnes , Hanbo Chen , Amandeep Taggar , Moti Paudel , Liying Zhang , Aishah Alqaderi , Eric Leung

INTRODUCTION

Interstitial brachytherapy (ISBT) is a known treatment for vaginal recurrence of endometrial cancer. This study reviews a large tertiary institution's ISBT experience and outcomes for vaginal recurrences.

MATERIAL AND METHODS

Patients who underwent salvage ISBT for vaginal recurrence of endometrial cancer from January 1, 2014 to August 31, 2021, were identified. Initial and salvage disease factors and treatments were recorded. Outcomes were calculated including overall survival, local, and distant failure.

RESULTS

Thirty-nine patients were included; thirty received external beam radiotherapy and interstitial brachytherapy (EBRT + ISBT) while 9 received ISBT alone. At initial diagnosis, the ISBT alone group had an older median age, with stage IA-IV disease, frequently receiving adjuvant treatment, compared to the EBRT with ISBT group with mainly stage IA disease who did not. Median follow up was 22 months and median time to recurrence 14 months (16.5 months in EBRT + ISBT group and 14 in the ISBT alone group). Two-year overall survival was 85% for all patients, 85.6% and 83.3%in the EBRT + ISBT and ISBT alone groups, respectively. Local failure was 22.7% for all patients, 16.7% in the EBRT + ISBT group and 11.1% in the ISBT alone group. Median HRCTV D90 (EQD2) was 76.8 Gy in the EBRT + ISBT group, and 57.9 Gy in the ISBT alone group. Late grade 3 or higher toxicity occurred in only 3 patients.

CONCLUSIONS

EBRT + ISBT is an effective treatment for endometrial cancer vaginal recurrence, with acceptable toxicity. ISBT alone is an option for patients with contraindications to or with previous treatment of pelvic radiation.
简介间质近距离放射治疗(ISBT)是一种已知的治疗子宫内膜癌阴道复发的方法。本研究回顾了一家大型三级医疗机构在阴道复发方面的 ISBT 经验和结果:研究对象为2014年1月1日至2021年8月31日期间因子宫内膜癌阴道复发而接受ISBT挽救治疗的患者。记录初始和挽救性疾病因素及治疗方法。结果包括总生存期、局部和远处失败:共纳入 39 例患者,其中 30 例接受了体外放射治疗和间质近距离放射治疗(EBRT + ISBT),9 例仅接受了 ISBT。初诊时,单纯ISBT组患者的中位年龄较大,疾病处于IA-IV期,经常接受辅助治疗,而EBRT+ISBT组患者主要处于IA期,没有接受辅助治疗。中位随访时间为 22 个月,中位复发时间为 14 个月(EBRT + ISBT 组为 16.5 个月,单用 ISBT 组为 14 个月)。所有患者的两年总生存率为 85%,EBRT + ISBT 组和单纯 ISBT 组分别为 85.6% 和 83.3%。所有患者的局部失败率为 22.7%,EBRT + ISBT 组为 16.7%,单纯 ISBT 组为 11.1%。EBRT+ISBT组的中位HRCTV D90(EQD2)为76.8 Gy,单纯ISBT组为57.9 Gy。仅有3名患者出现了3级或3级以上的晚期毒性:结论:EBRT + ISBT 是治疗子宫内膜癌阴道复发的有效方法,毒性可接受。对于有盆腔放疗禁忌症或既往接受过盆腔放疗的患者,可选择单独使用 ISBT。
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引用次数: 0
Long-term disease-free survival and health-related quality of life results of high-dose-rate brachytherapy as monotherapy for low and intermediate-risk prostate cancer treated in a community cancer center 高剂量率近距离放射治疗作为社区癌症中心治疗低危和中危前列腺癌的单一疗法的长期无病生存率和与健康相关的生活质量结果。
IF 1.7 4区 医学 Q4 ONCOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.brachy.2024.10.004
Raphael William , Pierre-Yves McLaughlin , Mathieu Pharand-Charbonneau , Debbie Smith Wright , Alain Haddad , Marc Gaudet

PURPOSE

To determine the long-term disease-free survival, long-term toxicity, and effect on health-related quality of life of a two-fraction regimen of high-dose-rate (HDR) prostate brachytherapy.

METHODS AND MATERIALS

Patients with low- or intermediate-risk prostate cancer were treated with CT-planned HDR brachytherapy as monotherapy in two implants of 13.5 Gy in one community cancer center. Prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS) and Expanded Prostate Index Composite (EPIC) questionnaires were evaluated at each follow-up visit. Biochemical recurrence (Phoenix definition) was evaluated to determine disease-free survival at 5 and 7 years. Proportion of patients in each IPSS category (mild = 0–7, moderate = 8–18, severe = 19+) was evaluated at each follow-up interval.

RESULTS

Thirty patients were accrued to the study between 2014 and 2016. Median prostate-specific antigen was 8,7 (range 4.1–17.5). T stages were T1c = 65%, T2a = 21%, and T2b = 14%. Twenty-seven percent of patients had a Gleason score of 6 and 73% had a Gleason score of 7. 13% were in low risk category and 87% in intermediate risk category. Median follow-up was 84 months. There were no deaths at 84 months after brachytherapy. Disease-free survival was 90% at 5 years and 86% at 7 years. Two patients experienced late Grade 3 GU toxicity (6.6%).

CONCLUSIONS

This study serves as proof of concept that HDR monotherapy can be performed successfully with excellent long-term outcomes in a community cancer center with adequate training and experience. The long-term disease-free survival rate and the health-related quality of life seem acceptable as compared to other treatment modalities. Further study is ongoing with regard to the optimal dosing regimen for HDR monotherapy.
目的:确定高剂量率(HDR)前列腺近距离放射治疗的长期无病生存率、长期毒性以及对健康相关生活质量的影响:在一家社区癌症中心,低危或中危前列腺癌患者接受了CT计划的HDR近距离放射治疗,作为单一疗法,分两次植入13.5 Gy。每次随访时都会对前列腺特异性抗原(PSA)、国际前列腺症状评分(IPSS)和前列腺指数综合指数(EPIC)问卷进行评估。对生化复发(凤凰定义)进行评估,以确定5年和7年的无病生存率。在每个随访间隔期评估每个 IPSS 类别(轻度 = 0-7、中度 = 8-18、重度 = 19+)的患者比例:2014年至2016年期间,共有30名患者参与研究。前列腺特异性抗原中位数为8.7(范围4.1-17.5)。T分期为T1c=65%,T2a=21%,T2b=14%。27%的患者格里森评分为6分,73%的患者格里森评分为7分。中位随访时间为 84 个月。近距离放射治疗后 84 个月内无死亡病例。5年无病生存率为90%,7年无病生存率为86%。两名患者出现了晚期3级GU毒性(6.6%):这项研究证明了一个概念,即在受过充分培训并拥有丰富经验的社区癌症中心,可以成功实施 HDR 单一疗法,并取得良好的长期疗效。与其他治疗方式相比,长期无病生存率和与健康相关的生活质量似乎是可以接受的。有关 HDR 单一疗法最佳剂量方案的进一步研究仍在进行中。
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引用次数: 0
Dosimetric evaluation of adaptive planning for five-fraction gynecologic template-based interstitial brachytherapy 对基于妇科模板的五分段间质近距离放射治疗的自适应规划进行剂量学评估。
IF 1.7 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.brachy.2024.07.007
Steven Blum , Jessica R. Miller , Kristin A. Bradley , Bethany Anderson , Hari Menon , Bradley Eckelmann , Charles Wallace , Abby Besemer , Michael Lawless , Jordan M. Slagowski

PURPOSE

The purpose of this work was to evaluate whether inter-fraction imaging and replanning enhance treatment delivery adherence to clinical planning objectives in the context of a 5-fraction template-based interstitial brachytherapy (TISB) approach for gynecologic cancer treatment.

METHODS AND MATERIALS

This retrospective study analyzed nineteen patients who underwent 5 fractions of interstitial brachytherapy over 3 days using the Syed–Neblett template. A verification CT scan was acquired for applicator assessment and reviewed by a radiation oncologist and medical physicist before each fraction. Eleven patients required replanning at least once during the treatment course. Replanning on the verification CT scan consisted of generating new target and organ-at-risk contours, digitizing catheter positions, and optimizing source dwell times to meet planning objectives. Dwell times and positions from the initial treatment plan were evaluated on the new contours to assess the dose that would have been delivered without replanning (nonadapted). Significance of nonadapted versus adapted dose differences were evaluated using a 2-sided Wilcoxon sum rank test.

RESULTS

The average (min, max) change in dose (Gy) between the clinically delivered plans and the nonadapted plans were HR-CTV D90%: −6.5 (−0.6, −15.1), HR-CTV D98%: −6.5 (−0.4, −12.6), Bladder D2cc: −0.5 (0.0, −2.8), Bowel D2cc: −0.8 (0.0, −3.2), Rectum D2cc: −1.1 (0.0, −11.5), Sigmoid D2cc: −1.4 (−0.1, −5.4). Dosimetric changes in HR-CTV coverage were significantly improved with replanning while organ-at-risk differences were nonsignificant (p > 0.05). Fraction 3 was the most common fraction indicated for replanning.

CONCLUSIONS

Replanning template-based interstitial brachytherapy can improve target coverage and adherence to planning goals.
目的:这项研究的目的是评估在采用基于模板的5个分段间质近距离放射治疗(TISB)方法治疗妇科癌症时,分段间成像和重新规划是否能提高治疗效果,使其更符合临床计划目标:这项回顾性研究分析了19名患者,他们在3天内使用Syed-Neblett模板接受了5次间质近距离放射治疗。每次分次治疗前,放射肿瘤学家和医学物理学家都会对患者进行CT扫描验证,以评估施术者的情况。有 11 名患者在治疗过程中至少需要重新扫描一次。对验证 CT 扫描的重新扫描包括生成新的目标和危险器官轮廓、数字化导管位置以及优化放射源停留时间,以达到计划目标。在新轮廓上评估初始治疗计划中的停留时间和位置,以评估未重新规划(非适应)情况下的剂量。使用双侧 Wilcoxon 和秩检验来评估非适应与适应剂量差异的显著性:临床实施计划与非适应计划之间的平均(最小,最大)剂量变化(Gy)为 HR-CTV D90%:-6.5(-0.6,-15.1),HR-CTV D98%:-膀胱 D2cc:-0.5(0.0,-2.8),肠 D2cc:-0.8(0.0,-3.2),直肠 D2cc:-1.1(0.0,-11.5),乙状结肠 D2cc:-1.4(-0.1,-5.4)。重新扫描后,HR-CTV 覆盖范围的剂量学变化明显改善,而风险器官的差异不显著(P > 0.05)。3号分段是最常见的重新扫描分段:结论:重新规划基于模板的间质近距离放射治疗可提高靶点覆盖率,并更好地实现规划目标。
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引用次数: 0
Gynecological brachytherapy hybrid training: The Tata Memorial Centre and BrachyAcademy experience 妇科近距离治疗混合培训:塔塔纪念中心和 BrachyAcademy 的经验。
IF 1.7 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.brachy.2024.07.002
Elena Dizendorf , Supriya Chopra , Prachi Mittal , Ankita Gupta , Remi Nout , Alina Sturdza , Cyrus Chargari , Kari Tanderup , Ekkasit Tharavichitkul , Hamza Tatli , Meenakshi Jeeva , Jeevanshu Jain , Subhajit Panda , Ritu Raj Upreti , Yogesh Ghadi , Akshay Bhavke , Satish Kohle , Rajesh Bhajbhuje , Jai Prakash Agarwal

PURPOSE

The lack of training is a significant barrier to practicing brachytherapy (BT). Tata Memorial Centre, alongside international BT experts and BrachyAcademy, developed a hybrid gynecological BT training module. This study outlines the preparation, organization, and execution of the 2022–2023 Mumbai training, evaluates its effectiveness, and highlights areas for improvement.

MATERIALS AND METHODS

Participants were radiation oncologists (RO) and medical physicists (MP) with experience in gynecological BT aiming to transition to image-guided brachytherapy (IGBT). The training covered cervical, endometrial, vaginal, vulvar, periurethral cancers, and pelvic reirradiation. The hybrid course included online pre and postcourse homework assignments, a live workshop with hands-on training, a 6-month online follow-up, and a 12-month opportunity to share the transition experience.

RESULTS

The December 2022 Mumbai live workshop spanned 2.5 days, attracting 39 participants from 8 countries (Asia, Africa, Australia/Oceania). Feedback rated the course 9/10, with 78% fully meeting expectations. Forty-four percent suggested extending hands-on training. At the 6-month follow-up, response rates were low (33% RO, 11% MP). Among responding RO, 70% reported practice changes after attending the course, 40% implemented IGBT concepts in clinical practice, and 50% increased confidence in image-guided procedures. Overall, 45% of respondent sites could strengthen their intracavitary/interstitial program, while others faced limitations due to lack of access to advanced BT applicators.

CONCLUSION

The hybrid gynecological BT training concept was successfully executed. Areas for improvement include extending hands-on training and enhancing participant engagement postcourse. Structured steps beyond training may be needed to improve the utilization of advanced brachytherapy for gynecological cancers.
目的:缺乏培训是从事近距离放射治疗(BT)的一大障碍。塔塔纪念中心与国际近距离放射治疗专家和BrachyAcademy共同开发了妇科近距离放射治疗混合培训模块。本研究概述了 2022-2023 年孟买培训的筹备、组织和实施情况,评估了培训效果,并强调了需要改进的地方:参加培训的人员是放射肿瘤学家(RO)和医学物理学家(MP),他们在妇科近距离放射治疗(BT)方面具有丰富的经验,目标是过渡到图像引导近距离放射治疗(IGBT)。培训内容包括宫颈癌、子宫内膜癌、阴道癌、外阴癌、尿道周围癌和盆腔再放射。混合课程包括在线课前和课后作业、现场研讨会与实践培训、为期6个月的在线随访以及为期12个月的分享过渡经验的机会:2022 年 12 月在孟买举办的现场研讨会为期 2.5 天,吸引了来自 8 个国家(亚洲、非洲、澳大利亚/大洋洲)的 39 名学员参加。反馈意见对课程的评分为 9/10,78% 完全符合预期。44%的学员建议延长实践培训时间。在 6 个月的跟踪调查中,答复率较低(33% 的区域办事处,11% 的 MP)。在答复的区域办事处中,70% 的办事处表示在参加课程后改变了做法,40% 的办事处在临床实践中实施了 IGBT 概念,50% 的办事处增强了对图像引导程序的信心。总体而言,45%的受访医疗机构可以加强其腔内/间质治疗项目,而其他医疗机构则因无法获得先进的 BT 应用器械而面临限制:结论:混合妇科 BT 培训概念已成功实施。需要改进的方面包括扩大实践培训和加强学员课后参与。除了培训之外,可能还需要采取结构化措施,以提高先进近距离放射治疗妇科癌症的利用率。
{"title":"Gynecological brachytherapy hybrid training: The Tata Memorial Centre and BrachyAcademy experience","authors":"Elena Dizendorf ,&nbsp;Supriya Chopra ,&nbsp;Prachi Mittal ,&nbsp;Ankita Gupta ,&nbsp;Remi Nout ,&nbsp;Alina Sturdza ,&nbsp;Cyrus Chargari ,&nbsp;Kari Tanderup ,&nbsp;Ekkasit Tharavichitkul ,&nbsp;Hamza Tatli ,&nbsp;Meenakshi Jeeva ,&nbsp;Jeevanshu Jain ,&nbsp;Subhajit Panda ,&nbsp;Ritu Raj Upreti ,&nbsp;Yogesh Ghadi ,&nbsp;Akshay Bhavke ,&nbsp;Satish Kohle ,&nbsp;Rajesh Bhajbhuje ,&nbsp;Jai Prakash Agarwal","doi":"10.1016/j.brachy.2024.07.002","DOIUrl":"10.1016/j.brachy.2024.07.002","url":null,"abstract":"<div><h3>PURPOSE</h3><div>The lack of training is a significant barrier to practicing brachytherapy (BT). Tata Memorial Centre, alongside international BT experts and BrachyAcademy, developed a hybrid gynecological BT training module. This study outlines the preparation, organization, and execution of the 2022–2023 Mumbai training, evaluates its effectiveness, and highlights areas for improvement.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Participants were radiation oncologists (RO) and medical physicists (MP) with experience in gynecological BT aiming to transition to image-guided brachytherapy (IGBT). The training covered cervical, endometrial, vaginal, vulvar, periurethral cancers, and pelvic reirradiation. The hybrid course included online pre and postcourse homework assignments, a live workshop with hands-on training, a 6-month online follow-up, and a 12-month opportunity to share the transition experience.</div></div><div><h3>RESULTS</h3><div>The December 2022 Mumbai live workshop spanned 2.5 days, attracting 39 participants from 8 countries (Asia, Africa, Australia/Oceania). Feedback rated the course 9/10, with 78% fully meeting expectations. Forty-four percent suggested extending hands-on training. At the 6-month follow-up, response rates were low (33% RO, 11% MP). Among responding RO, 70% reported practice changes after attending the course, 40% implemented IGBT concepts in clinical practice, and 50% increased confidence in image-guided procedures. Overall, 45% of respondent sites could strengthen their intracavitary/interstitial program, while others faced limitations due to lack of access to advanced BT applicators.</div></div><div><h3>CONCLUSION</h3><div>The hybrid gynecological BT training concept was successfully executed. Areas for improvement include extending hands-on training and enhancing participant engagement postcourse. Structured steps beyond training may be needed to improve the utilization of advanced brachytherapy for gynecological cancers.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 648-659"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
GF479-Elsevier-www.theclinics.com-Our Issues Can Help You Manage…-BW GF479-Elsevier-www.theclinics.com-Our 问题可以帮助您管理...-BW
IF 1.7 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1016/S1538-4721(24)00435-5
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引用次数: 0
Surgically targeted radiation therapy versus stereotactic radiation therapy: A dosimetric comparison for brain metastasis resection cavities 手术靶向放射治疗与立体定向放射治疗:脑转移瘤切除腔的剂量比较。
IF 1.7 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.brachy.2024.06.007
Tugce Kutuk , Rupesh Kotecha , Roberto Herrera , D Jay J. Wieczorek , Zachary W. Fellows , Vibha Chaswal , Alonso La Rosa , Vivek Mishra , Michael W. McDermott , Vitaly Siomin , Minesh P. Mehta , Alonso N. Gutierrez , Ranjini Tolakanahalli

PURPOSE

Surgically targeted radiation therapy (STaRT) with Cesium-131 seeds embedded in a collagen tile is a promising treatment for recurrent brain metastasis. In this study, the biological effective doses (BED) for normal and target tissues from STaRT plans were compared with those of external beam radiotherapy (EBRT) modalities.

METHODS

Nine patients (n = 9) with 12 resection cavities (RCs) who underwent STaRT (cumulative physical dose of 60 Gy to a depth of 5 mm from the RC edge) were replanned with CyberKnife (CK), Gamma Knife (GK), and intensity modulated proton therapy (IMPT) using an SRT approach (30 Gy in 5 fractions). Statistical significance comparing D95% and D90% in BED10Gy (BED10Gy95% and BED10Gy90%) and to RC + 0 to + 5 mm expansion margins, and parameters associated with radiation necrosis risk (V83Gy, V103Gy, V123Gy and V243Gy) to the normal brain were evaluated by a Wilcoxon-signed rank test.

RESULTS

For RC + 0 mm, median BED10Gy 90% for STaRT (90.1 Gy10, range: 64.1–140.9 Gy10) was significantly higher than CK (74.3 Gy10, range:59.3–80.4 Gy10, p = 0.04), GK (69.4 Gy10, range: 59.8–77.1 Gy10, p = 0.005), and IMPT (49.3 Gy10, range: 49.0–49.7 Gy10, p = 0.003), respectively. However, for the RC + 5 mm, the median BED10Gy 90% for STaRT (34.1 Gy10, range: 22.2–59.7 Gy10) was significantly lower than CK (44.3 Gy10, range: 37.8–52.4 Gy10), and IMPT (46.6 Gy10, range: 45.1–48.5 Gy10), respectively, but not significantly different from GK (34.1 Gy10, range: 22.8–47.0 Gy10). The median V243Gy was significantly higher in CK (11.7 cc, range: 4.7–20.1 cc), GK(6.2 cc, range: 2.3–11.9 cc) and IMPT (19.9 cc, range: 11.1–36.6 cc) compared to STaRT (1.1 cc, range: 0.0–7.8 cc) (p < 0.01).

CONCLUSIONS

This comparative analysis suggests a STaRT approach may treat recurrent brain tumors effectively via delivery of higher radiation doses with equivalent or greater BED up to at least 3 mm from the RC edge as compared to EBRT approaches.
目的:将铯-131种子嵌入胶原瓦中进行手术靶向放射治疗(STaRT)是一种治疗复发性脑转移瘤的有效方法。本研究将 STaRT 计划对正常组织和靶组织的生物有效剂量(BED)与外照射放疗(EBRT)模式进行了比较:九名患者(n = 9)有 12 个切除腔(RC),他们接受了 STaRT(RC 边缘 5 mm 深度的累积物理剂量为 60 Gy),并使用 CyberKnifeⓇ (CK)、伽玛刀Ⓡ (GK) 和强度调制质子疗法 (IMPT) 进行了 SRT 方法(30 Gy,分 5 次进行)的重新计划。BED10Gy的D95%和D90%(BED10Gy95%和BED10Gy90%)与RC + 0至+ 5 mm扩展边缘的统计意义,以及与正常脑放射坏死风险相关的参数(V83Gy、V103Gy、V123Gy和V243Gy),均通过Wilcoxon-signed秩检验进行评估:对于 RC + 0 mm,START 的中位 BED10Gy 90%(90.1 Gy10,范围:64.1-140.9 Gy10)明显高于 CK(74.3 Gy10,范围:59.3-80.4 Gy10,p = 0.04)、GK(69.4 Gy10,范围:59.8-77.1 Gy10,p = 0.005)和 IMPT(49.3 Gy10,范围:49.0-49.7 Gy10,p = 0.003)。然而,对于 RC + 5 mm,STaRT 的中位 BED10Gy 90%(34.1 Gy10,范围:22.2-59.7 Gy10)分别显著低于 CK(44.3 Gy10,范围:37.8-52.4 Gy10)和 IMPT(46.6 Gy10,范围:45.1-48.5 Gy10),但与 GK(34.1 Gy10,范围:22.8-47.0 Gy10)无显著差异。与 STaRT(1.1 cc,范围:0.0-7.8 cc)相比,CK(11.7 cc,范围:4.7-20.1 cc)、GK(6.2 cc,范围:2.3-11.9 cc)和 IMPT(19.9 cc,范围:11.1-36.6 cc)的中位 V243Gy 明显更高(P < 0.01):这项对比分析表明,与 EBRT 方法相比,STaRT 方法可以通过在距离 RC 边缘至少 3 mm 的范围内提供更高的放射剂量和等效或更高的 BED 来有效治疗复发性脑肿瘤。
{"title":"Surgically targeted radiation therapy versus stereotactic radiation therapy: A dosimetric comparison for brain metastasis resection cavities","authors":"Tugce Kutuk ,&nbsp;Rupesh Kotecha ,&nbsp;Roberto Herrera ,&nbsp;D Jay J. Wieczorek ,&nbsp;Zachary W. Fellows ,&nbsp;Vibha Chaswal ,&nbsp;Alonso La Rosa ,&nbsp;Vivek Mishra ,&nbsp;Michael W. McDermott ,&nbsp;Vitaly Siomin ,&nbsp;Minesh P. Mehta ,&nbsp;Alonso N. Gutierrez ,&nbsp;Ranjini Tolakanahalli","doi":"10.1016/j.brachy.2024.06.007","DOIUrl":"10.1016/j.brachy.2024.06.007","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Surgically targeted radiation therapy (STaRT) with Cesium-131 seeds embedded in a collagen tile is a promising treatment for recurrent brain metastasis. In this study, the biological effective doses (BED) for normal and target tissues from STaRT plans were compared with those of external beam radiotherapy (EBRT) modalities.</div></div><div><h3>METHODS</h3><div>Nine patients (n = 9) with 12 resection cavities (RCs) who underwent STaRT (cumulative physical dose of 60 Gy to a depth of 5 mm from the RC edge) were replanned with CyberKnife<sup>Ⓡ</sup> (CK), Gamma Knife<sup>Ⓡ</sup> (GK), and intensity modulated proton therapy (IMPT) using an SRT approach (30 Gy in 5 fractions). Statistical significance comparing D95% and D90% in BED<sub>10Gy</sub> (BED<sub>10Gy</sub>95% and BED<sub>10Gy</sub>90%) and to RC + 0 to + 5 mm expansion margins, and parameters associated with radiation necrosis risk (V8<sub>3Gy</sub>, V10<sub>3Gy</sub>, V12<sub>3Gy</sub> and V24<sub>3Gy</sub>) to the normal brain were evaluated by a Wilcoxon-signed rank test.</div></div><div><h3>RESULTS</h3><div>For RC + 0 mm, median BED<sub>10Gy</sub> 90% for STaRT (90.1 Gy<sub>10</sub>, range: 64.1–140.9 Gy<sub>10</sub>) was significantly higher than CK (74.3 Gy<sub>10</sub>, range:59.3–80.4 Gy<sub>10</sub>, <em>p =</em> 0.04), GK (69.4 Gy<sub>10</sub>, range: 59.8–77.1 Gy<sub>10</sub>, <em>p =</em> 0.005), and IMPT (49.3 Gy<sub>10</sub>, range: 49.0–49.7 Gy<sub>10</sub>, <em>p =</em> 0.003), respectively. However, for the RC + 5 mm, the median BED<sub>10Gy</sub> 90% for STaRT (34.1 Gy<sub>10</sub>, range: 22.2–59.7 Gy<sub>10</sub>) was significantly lower than CK (44.3 Gy<sub>10</sub>, range: 37.8–52.4 Gy<sub>10</sub>), and IMPT (46.6 Gy<sub>10</sub>, range: 45.1–48.5 Gy<sub>10</sub>), respectively, but not significantly different from GK (34.1 Gy<sub>10</sub>, range: 22.8–47.0 Gy<sub>10</sub>). The median V24<sub>3Gy</sub> was significantly higher in CK (11.7 cc, range: 4.7–20.1 cc), GK(6.2 cc, range: 2.3–11.9 cc) and IMPT (19.9 cc, range: 11.1–36.6 cc) compared to STaRT (1.1 cc, range: 0.0–7.8 cc) (<em>p</em> &lt; 0.01).</div></div><div><h3>CONCLUSIONS</h3><div>This comparative analysis suggests a STaRT approach may treat recurrent brain tumors effectively via delivery of higher radiation doses with equivalent or greater BED up to at least 3 mm from the RC edge as compared to EBRT approaches.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 751-760"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mortality and postinterventional complications after ablative treatment of liver malignancies: A cohort study of 4374 patients 肝脏恶性肿瘤消融治疗后的死亡率和介入治疗后并发症:4374 例患者的队列研究。
IF 1.7 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.brachy.2024.07.001
Christine March , Maximilian Thormann , Peter Hass , Marilena Georgiades , Maximilian Sensse , Tim Herrmann , Jazan Omari , Maciej Pech , Robert Damm

PURPOSE

Ablative therapies for primary and secondary liver malignancies are increasingly adopted in current guidelines. Nevertheless, surgical resection remains the gold standard in most curative therapy settings.
Extensive studies on mortality and morbidity after ablative treatment of the liver are missing. We investigated complications and mortality after ablative treatment in a large, unselected study cohort.

MATERIALS AND METHODS

Standardized patient and treatment data in 4374 percutaneous and angiographic ablative procedures of the liver from the DRG-based hospital reimbursement system (diagnosis-related groups) of an academic hospital in Germany were retrospectively evaluated. We analyzed descriptive patient data, length of stay (LOS), pre-existing medical conditions, previous gastrointestinal surgeries, severe complications, and occurrence of death.

RESULTS

Treatment of secondary liver malignancies constituted over two-thirds of all procedures (71%, n = 3053). The mean LOS was 4.1 ± 3.5 days. Severe complications were documented in 1.4% and in-house death in 0.2% of cases, significantly more often after treatment with chemoembolization of primary liver malignancies (p = 0.003; p = 0.0001).
Previous partial liver resection, partial bowel resection, and chronic renal failure were independent risk factors for the occurrence of severe complications.

CONCLUSION

Severe complications and in-hospital death are rare in the treatment of primary and secondary liver malignancies with percutaneous and angiographic procedures.
They are a viable alternative or addition to a surgical approach in treating liver lesions.
目的:目前的指南越来越多地采用烧蚀疗法治疗原发性和继发性肝脏恶性肿瘤。然而,手术切除仍是大多数治愈性治疗的金标准。有关肝脏消融治疗后死亡率和发病率的广泛研究尚属空白。我们在一个未经选择的大型研究队列中调查了消融治疗后的并发症和死亡率:我们对德国一家学术医院基于 DRG 的医院报销系统(诊断相关组)中 4374 例经皮和血管造影肝脏消融术的标准化患者和治疗数据进行了回顾性评估。我们分析了患者的描述性数据、住院时间(LOS)、既往病史、既往胃肠道手术、严重并发症和死亡情况:继发性肝脏恶性肿瘤的治疗占所有手术的三分之二以上(71%,n = 3053)。平均住院日为 4.1 ± 3.5 天。有记录显示,1.4%的病例出现严重并发症,0.2%的病例出现内部死亡,原发性肝脏恶性肿瘤化疗栓塞治疗后出现严重并发症的病例明显增多(p = 0.003; p = 0.0001)。曾进行肝部分切除术、肠部分切除术和慢性肾功能衰竭是发生严重并发症的独立危险因素:结论:采用经皮和血管造影术治疗原发性和继发性肝脏恶性肿瘤时,很少出现严重并发症和院内死亡。在治疗肝脏病变时,经皮和血管造影术是一种可行的替代或补充手术方法。
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引用次数: 0
3D-printed individual template brachytherapy for the treatment of intractable central pelvic recurrent cervical cancer: A single institution experience 用于治疗难治性中央盆腔复发性宫颈癌的 3D 打印个体模板近距离放射治疗:单一机构的经验。
IF 1.7 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.brachy.2024.05.004
Xiaolu Zhu , Manting Zeng , Youyi Dai , Weilu Kuang , Zijian Zhang , Shan Li , Hong Zhu

OBJECTIVE

The prognosis of recurrent cervical cancer tends to be poor and there are limited effective treatments currently available for these patients. This study was developed to find a safe and effective treatment for patients with central pelvic recurrent cervical cancer.

MATERIALS AND METHODS

This retrospective study analyzed patients with central pelvic recurrent cervical cancer who received 3D-printed individual template (3D-PIT) brachytherapy between February 2019 and June 2023. Analyses of dosimetric parameters, toxicity-related complications, and survival were conducted based on the data of these patients.

RESULTS

Twenty-one patients with central pelvic recurrent cervical cancer patients were enrolled. All of them received 3D-printed individual template (3D-PIT) brachytherapy. The mean respective adjusted cumulative HRCTV-D90 and HRCTV-D98 values for these patients were 86.9 Gy and 75.4 Gy. And the local control (LC) rate of these patients was 57.1%. In these 21 patients, only 2 (9.5%) of them experienced grade 3–4 rectal adverse reactions, while 7 (33.3%) patients experienced grade 3–4 bladder adverse reactions. 5(23.8%) patients had fistula, while 3 of these 5 patients had undergone prior anti-VEGF targeted drug treatment which is a risk factor of fistula. The respective 2-year rates of overall and progression-free survival (OS and PFS) for these patients were 72.9% and 57.4%, with a 26-month median PFS.

CONCLUSIONS

These single-institution data highlight the potential viability of 3D-PIT brachytherapy as an approach to managing intractable central pelvic recurrent cervical cancer following first-line treatment.
目的:复发性宫颈癌的预后往往较差,目前可用于这些患者的有效治疗方法有限。本研究旨在为中央盆腔复发性宫颈癌患者找到一种安全有效的治疗方法:这项回顾性研究分析了2019年2月至2023年6月期间接受3D打印个体模板(3D-PIT)近距离治疗的中央盆腔复发性宫颈癌患者。根据这些患者的数据对剂量参数、毒性相关并发症和生存期进行了分析:21名中央盆腔复发性宫颈癌患者入选。所有患者都接受了三维打印个体模板(3D-PIT)近距离放射治疗。这些患者的调整后累积 HRCTV-D90 和 HRCTV-D98 的平均值分别为 86.9 Gy 和 75.4 Gy。这些患者的局部控制率(LC)为 57.1%。在这 21 例患者中,只有 2 例(9.5%)出现了 3-4 级直肠不良反应,7 例(33.3%)出现了 3-4 级膀胱不良反应。5例(23.8%)患者出现了瘘管,而这5例患者中有3例之前接受过抗血管内皮生长因子靶向药物治疗,这是瘘管的一个风险因素。这些患者的2年总生存率和无进展生存率(OS和PFS)分别为72.9%和57.4%,中位PFS为26个月:这些单个机构的数据突出表明,3D-PIT近距离放射治疗是治疗一线治疗后难治性盆腔中心复发性宫颈癌的一种潜在可行方法。
{"title":"3D-printed individual template brachytherapy for the treatment of intractable central pelvic recurrent cervical cancer: A single institution experience","authors":"Xiaolu Zhu ,&nbsp;Manting Zeng ,&nbsp;Youyi Dai ,&nbsp;Weilu Kuang ,&nbsp;Zijian Zhang ,&nbsp;Shan Li ,&nbsp;Hong Zhu","doi":"10.1016/j.brachy.2024.05.004","DOIUrl":"10.1016/j.brachy.2024.05.004","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>The prognosis of recurrent cervical cancer tends to be poor and there are limited effective treatments currently available for these patients. This study was developed to find a safe and effective treatment for patients with central pelvic recurrent cervical cancer.</div></div><div><h3>MATERIALS AND METHODS</h3><div>This retrospective study analyzed patients with central pelvic recurrent cervical cancer who received 3D-printed individual template (3D-PIT) brachytherapy between February 2019 and June 2023. Analyses of dosimetric parameters, toxicity-related complications, and survival were conducted based on the data of these patients.</div></div><div><h3>RESULTS</h3><div>Twenty-one patients with central pelvic recurrent cervical cancer patients were enrolled. All of them received 3D-printed individual template (3D-PIT) brachytherapy. The mean respective adjusted cumulative HRCTV-D90 and HRCTV-D98 values for these patients were 86.9 Gy and 75.4 Gy. And the local control (LC) rate of these patients was 57.1%. In these 21 patients, only 2 (9.5%) of them experienced grade 3–4 rectal adverse reactions, while 7 (33.3%) patients experienced grade 3–4 bladder adverse reactions. 5(23.8%) patients had fistula, while 3 of these 5 patients had undergone prior anti-VEGF targeted drug treatment which is a risk factor of fistula. The respective 2-year rates of overall and progression-free survival (OS and PFS) for these patients were 72.9% and 57.4%, with a 26-month median PFS.</div></div><div><h3>CONCLUSIONS</h3><div>These single-institution data highlight the potential viability of 3D-PIT brachytherapy as an approach to managing intractable central pelvic recurrent cervical cancer following first-line treatment.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 634-640"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Commissioning considerations for the Bravos high-dose-rate afterloader: Towards improving treatment delivery accuracy Bravos 高剂量率后装载器的调试注意事项:提高治疗精确度。
IF 1.7 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.brachy.2024.06.010
Gil'ad N. Cohen , Xiuxiu He , Michael Trager , Maria F. Chan , Jeonghoon Park , Antonio L. Damato , David Aramburu Nunez

BACKGROUND And PURPOSE

The upgrade of major equipment can be disruptive to clinical operations and introduce risk as policy and procedures need to adapt to new technical possibilities and constraints. We describe here the transition from GammaMedPlus-iX to Bravos in a busy brachytherapy clinic, involving four afterloaders across two sites.

MATERIAL And METHODS

Our clinic employs three high-dose-rate remote afterloaders in four dedicated treatment vaults at the main site and a fourth afterloader at a regional location. Of more than 600 new HDR treatment plans performed annually, most are planned and treated intraoperatively. Most treatments are for prostate cancer, followed by GYN, intraoperative brachytherapy, GI, and other sites. Applicators used include vendor-provided applicators as well as third party applicators and in-house 3D-printed devices to provide interstitial, intracavitary, intraluminal, and surface treatments. All applicators were commissioned according to recommended guidelines. The choice of tolerances and the design of new procedures were informed by current guidelines and leveraged new HDR afterloader functionalities. A review of clinical operations in the 4 months postupgrade was conducted to evaluate the feasibility of new tolerances and the effectiveness of new procedures.

RESULTS

The procedures outlined improved and standardized afterloader QA and treatment protocols with clear actionable steps for staff to follow to ensure treatments are delivered as planned. Re-commissioning of applicators yielded results similar to those previously reported by other investigators. A review of initial treatment data revealed that in one case, due to the implementation of tight tolerances, obstruction near the tip of the channel was detected and corrected prior to treatment. It confirms that the implementation of the tolerances adopted is feasible and effective in flagging treatment deviations.

CONCLUSION

Enhanced procedures and QA processes were implemented successfully. We established clear actionable steps to follow by staff to ensure that treatments are delivered accurately.
背景和目的:由于政策和程序需要适应新的技术可能性和限制,因此主要设备的升级可能会扰乱临床操作并带来风险。我们在此介绍一家繁忙的近距离放射治疗诊所从 GammaMedPlus-iX 到 Bravos 的过渡过程,其中涉及两个地点的四台后装载器:材料: 我们诊所在主站的四个专用治疗库中使用了三台高剂量率远程后装机,在一个区域地点使用了第四台后装机。在每年进行的 600 多例新的 HDR 治疗计划中,大多数都是在术中计划和治疗的。大多数治疗是针对前列腺癌,其次是妇科、术中近距离放射治疗、消化道和其他部位。使用的涂抹器包括供应商提供的涂抹器、第三方涂抹器和内部 3D 打印设备,以提供间质、腔内、腔内和表面治疗。所有涂抹器都是根据推荐准则调试的。公差的选择和新程序的设计均参考了现行指南,并充分利用了新的 HDR 后装载器功能。对升级后 4 个月的临床操作进行了回顾,以评估新公差的可行性和新程序的有效性:结果:程序概述了经过改进和标准化的后装载器质量保证和治疗方案,为员工提供了明确的可操作步骤,以确保按计划进行治疗。重新调试施药器的结果与其他调查人员之前报告的结果相似。对初始处理数据的审查显示,在一个案例中,由于执行了严格的公差,在处理前发现并纠正了通道顶端附近的阻塞。这证实了所采取的公差措施是可行的,并能有效地发现治疗偏差:我们成功实施了强化程序和质量保证流程。我们为员工制定了明确的可操作步骤,以确保治疗的准确性。
{"title":"Commissioning considerations for the Bravos high-dose-rate afterloader: Towards improving treatment delivery accuracy","authors":"Gil'ad N. Cohen ,&nbsp;Xiuxiu He ,&nbsp;Michael Trager ,&nbsp;Maria F. Chan ,&nbsp;Jeonghoon Park ,&nbsp;Antonio L. Damato ,&nbsp;David Aramburu Nunez","doi":"10.1016/j.brachy.2024.06.010","DOIUrl":"10.1016/j.brachy.2024.06.010","url":null,"abstract":"<div><h3>BACKGROUND And PURPOSE</h3><div>The upgrade of major equipment can be disruptive to clinical operations and introduce risk as policy and procedures need to adapt to new technical possibilities and constraints. We describe here the transition from GammaMed<em>Plus</em>-iX to Bravos in a busy brachytherapy clinic, involving four afterloaders across two sites.</div></div><div><h3>MATERIAL And METHODS</h3><div>Our clinic employs three high-dose-rate remote afterloaders in four dedicated treatment vaults at the main site and a fourth afterloader at a regional location. Of more than 600 new HDR treatment plans performed annually, most are planned and treated intraoperatively. Most treatments are for prostate cancer, followed by GYN, intraoperative brachytherapy, GI, and other sites. Applicators used include vendor-provided applicators as well as third party applicators and in-house 3D-printed devices to provide interstitial, intracavitary, intraluminal, and surface treatments. All applicators were commissioned according to recommended guidelines. The choice of tolerances and the design of new procedures were informed by current guidelines and leveraged new HDR afterloader functionalities. A review of clinical operations in the 4 months postupgrade was conducted to evaluate the feasibility of new tolerances and the effectiveness of new procedures.</div></div><div><h3>RESULTS</h3><div>The procedures outlined improved and standardized afterloader QA and treatment protocols with clear actionable steps for staff to follow to ensure treatments are delivered as planned. Re-commissioning of applicators yielded results similar to those previously reported by other investigators. A review of initial treatment data revealed that in one case, due to the implementation of tight tolerances, obstruction near the tip of the channel was detected and corrected prior to treatment. It confirms that the implementation of the tolerances adopted is feasible and effective in flagging treatment deviations.</div></div><div><h3>CONCLUSION</h3><div>Enhanced procedures and QA processes were implemented successfully. We established clear actionable steps to follow by staff to ensure that treatments are delivered accurately.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 705-711"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comprehensive commissioning of a cone beam CT imaging ring for treatment of HDR GYN patients 全面调试锥形束 CT 成像环,用于治疗 HDR 妇科病人。
IF 1.7 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.brachy.2024.07.008
Cullen Boyle, Firas Mourtada, Rani Anne, Shuying Wan, Yingxuan Chen, Yevgeniy Vinogradskiy, Reza Taleei

PURPOSE

A new mobile cone beam computed tomography (CBCT) imaging ring (IRm, Elekta, v2.10.6, Veenendaal, Netherlands) has recently been proposed for brachytherapy to improve procedure efficiency. We describe the commissioning process and end-to-end tests for GYN HDR brachytherapy employing IRm CBCT imaging.

MATERIALS AND METHODS

Commissioning included imaging isocenter test, 3D image quality, 2D imaging quality, image dose, and tube characteristics. CIRS HDR GYN phantom and Venezia CT/MR gynecological applicator were used to perform end-to-end (E2E) tests and optimize workflow. Venezia applicator and four interstitial needles were inserted into the phantom and IRm CBCT images were acquired. Phantom and applicator were scanned with CT scanner (Siemens SOMATOM go.Open Pro) using department's pelvis imaging protocol. MR imaging was performed using 0.35T MR Linac TRUFI pulse sequence. CBCT images were registered to CT and MR using rigid registration to assess image quality and applicator geometry fidelity.

RESULTS

All physics tests passed within acceptance tolerances. Registration of CBCT images to MR and CT scans was acceptable for applicator placement. Applicator registration of CBCT images to CT demonstrated excellent agreement of most distal source dwell position (<1 mm). Slice thickness was also measured to be 1.25 mm, within 0.5 mm of its nominal value.

CONCLUSION

Based on E2E and commissioning results, IRm is an appropriate tool for brachytherapy treatment planning. This study demonstrated good image quality in GYN phantom and Venezia applicator using the IRm. Distal source dwell position agreement between CBCT and CT was acceptable for clinical use.
目的:最近提出了一种用于近距离放射治疗的新型移动锥形束计算机断层扫描(CBCT)成像环(IRm,Elekta,v2.10.6,Veenendaal,荷兰),以提高手术效率。我们介绍了采用 IRm CBCT 成像技术的妇科 HDR 近距离放射治疗的调试过程和端到端测试:调试包括成像等中心测试、3D 图像质量、2D 图像质量、图像剂量和管道特性。使用 CIRS HDR 妇科模型和 Venezia CT/MR 妇科涂抹器进行端到端(E2E)测试并优化工作流程。将 Venezia 施用器和四个间隙针插入模型,并获取 IRm CBCT 图像。使用 CT 扫描仪(西门子 SOMATOM go.Open Pro)对模型和敷贴器进行扫描,采用的是该部门的骨盆成像协议。使用 0.35T MR Linac TRUFI 脉冲序列进行磁共振成像。使用刚性配准将 CBCT 图像与 CT 和 MR 图像配准,以评估图像质量和涂抹器几何形状的保真度:结果:所有物理测试均在合格范围内。CBCT 图像与 MR 和 CT 扫描的配准对于涂抹器的放置是可以接受的。CBCT 图像与 CT 图像的涂抹器登记显示,最远距离的源驻留位置非常一致(结论:根据 E2E 和调试结果,IRm 是近距离放射治疗规划的合适工具。这项研究表明,使用 IRm 在 GYN 模型和 Venezia 治疗器上获得的图像质量很好。CBCT 和 CT 之间的远端放射源停留位置一致,可用于临床。
{"title":"Comprehensive commissioning of a cone beam CT imaging ring for treatment of HDR GYN patients","authors":"Cullen Boyle,&nbsp;Firas Mourtada,&nbsp;Rani Anne,&nbsp;Shuying Wan,&nbsp;Yingxuan Chen,&nbsp;Yevgeniy Vinogradskiy,&nbsp;Reza Taleei","doi":"10.1016/j.brachy.2024.07.008","DOIUrl":"10.1016/j.brachy.2024.07.008","url":null,"abstract":"<div><h3>PURPOSE</h3><div>A new mobile cone beam computed tomography (CBCT) imaging ring (IRm, Elekta, v2.10.6, Veenendaal, Netherlands) has recently been proposed for brachytherapy to improve procedure efficiency. We describe the commissioning process and end-to-end tests for GYN HDR brachytherapy employing IRm CBCT imaging.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Commissioning included imaging isocenter test, 3D image quality, 2D imaging quality, image dose, and tube characteristics. CIRS HDR GYN phantom and Venezia CT/MR gynecological applicator were used to perform end-to-end (E2E) tests and optimize workflow. Venezia applicator and four interstitial needles were inserted into the phantom and IRm CBCT images were acquired. Phantom and applicator were scanned with CT scanner (Siemens SOMATOM go.Open Pro) using department's pelvis imaging protocol. MR imaging was performed using 0.35T MR Linac TRUFI pulse sequence. CBCT images were registered to CT and MR using rigid registration to assess image quality and applicator geometry fidelity.</div></div><div><h3>RESULTS</h3><div>All physics tests passed within acceptance tolerances. Registration of CBCT images to MR and CT scans was acceptable for applicator placement. Applicator registration of CBCT images to CT demonstrated excellent agreement of most distal source dwell position (&lt;1 mm). Slice thickness was also measured to be 1.25 mm, within 0.5 mm of its nominal value.</div></div><div><h3>CONCLUSION</h3><div>Based on E2E and commissioning results, IRm is an appropriate tool for brachytherapy treatment planning. This study demonstrated good image quality in GYN phantom and Venezia applicator using the IRm. Distal source dwell position agreement between CBCT and CT was acceptable for clinical use.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 687-697"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Brachytherapy
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